Pretreatment alanine transaminase level may not be the most important predictor of HBeAg loss in the older patient

[Guest guest]

http://www3.interscience.wiley.com/journal/120751071/abstract

Liver International

Volume 29 Issue 2, Pages 231 - 236

Published Online: 10 Jul 2008

CLINICAL STUDIES

Pretreatment alanine transaminase level may not be the most important predictor

of HBeAg loss in the older patient

Jung Il Lee 1 , Hyun Joo Park 1 , Jin Woo Lee 1 , Young Soo Kim 1 , Seok Jeong 1

, Don Haeng Lee 1 , Hyung Gil Kim 1 , Yong Woon Shin 1 and Kye Sook Kwon 1

1 Department of Internal Medicine, Division of Gastroenterology, Inha

University College of Medicine, Incheon, Korea

Correspondence

Jung Il Lee, MD, Department of Internal Medicine, Division of Gastroenterology,

Inha University College of Medicine, 7-206, 3rd ST, Sinheung-Dong, Jung-Gu,

Incheon, 400-711, Korea

Tel: +82 32 890 2548

Fax: +82 32 890 2549

e-mail: mdflorence@...

ABSTRACT

Background: Elevated pretreatment alanine aminotransferase (ALT) over two times

the upper limit of normal reference range has been accepted as a marker for

predicting HBeAg loss and an indicator for initiating antiviral therapy.

Recently, several opinions argued that in patients aged over 40 years, the

treatment should be started if they have elevated serum hepatitis B virus (HBV)

DNA without elevated ALT. However, initiating treatment in these patients might

be argued against by the concept that the rate of HBeAg loss depends on the

pretreatment ALT.

Aim: This study was conducted to investigate the usefulness of pretreatment ALT

in predicting HBeAg loss in patients aged over 40 years under lamivudine

treatment.

Methods: We retrospectively analyzed 820 HBeAg-positive patients treated with

lamivudine. The patients with hepatocellular carcinoma at or after initiating

the lamivudine treatment and patients with evident liver cirrhosis were

excluded. Three hundred fifty-five patients met the criteria and were divided

into two groups: ¡Ü40 years of age (Group 1) and>40 years of age (Group 2).

Results: Analysis using the Kaplan¨CMeier method and the log rank test showed

that the cumulative rate of HBeAg loss was not different in the two groups.

Multivariate modelling indicated that an elevated pretreatment ALT level was a

predictor of HBeAg loss in Group 1 (P

[Guest guest]

http://www3.interscience.wiley.com/journal/120751071/abstract

Liver International

Volume 29 Issue 2, Pages 231 - 236

Published Online: 10 Jul 2008

CLINICAL STUDIES

Pretreatment alanine transaminase level may not be the most important predictor

of HBeAg loss in the older patient

Jung Il Lee 1 , Hyun Joo Park 1 , Jin Woo Lee 1 , Young Soo Kim 1 , Seok Jeong 1

, Don Haeng Lee 1 , Hyung Gil Kim 1 , Yong Woon Shin 1 and Kye Sook Kwon 1

1 Department of Internal Medicine, Division of Gastroenterology, Inha

University College of Medicine, Incheon, Korea

Correspondence

Jung Il Lee, MD, Department of Internal Medicine, Division of Gastroenterology,

Inha University College of Medicine, 7-206, 3rd ST, Sinheung-Dong, Jung-Gu,

Incheon, 400-711, Korea

Tel: +82 32 890 2548

Fax: +82 32 890 2549

e-mail: mdflorence@...

ABSTRACT

Background: Elevated pretreatment alanine aminotransferase (ALT) over two times

the upper limit of normal reference range has been accepted as a marker for

predicting HBeAg loss and an indicator for initiating antiviral therapy.

Recently, several opinions argued that in patients aged over 40 years, the

treatment should be started if they have elevated serum hepatitis B virus (HBV)

DNA without elevated ALT. However, initiating treatment in these patients might

be argued against by the concept that the rate of HBeAg loss depends on the

pretreatment ALT.

Aim: This study was conducted to investigate the usefulness of pretreatment ALT

in predicting HBeAg loss in patients aged over 40 years under lamivudine

treatment.

Methods: We retrospectively analyzed 820 HBeAg-positive patients treated with

lamivudine. The patients with hepatocellular carcinoma at or after initiating

the lamivudine treatment and patients with evident liver cirrhosis were

excluded. Three hundred fifty-five patients met the criteria and were divided

into two groups: ¡Ü40 years of age (Group 1) and>40 years of age (Group 2).

Results: Analysis using the Kaplan¨CMeier method and the log rank test showed

that the cumulative rate of HBeAg loss was not different in the two groups.

Multivariate modelling indicated that an elevated pretreatment ALT level was a

predictor of HBeAg loss in Group 1 (P